Understanding Lipodystrophy
Why HIV Treatment Changes Body Fat
HIV lipodystrophy syndrome involves two related but distinct problems. Lipoatrophy means loss of fat from certain areas - typically the face, arms, legs, and buttocks, leading to a gaunt appearance. Lipohypertrophy means accumulation of fat in other areas - especially deep in the abdomen (visceral fat), behind the neck ('buffalo hump'), and in the breasts.
This isn't just about appearance. Visceral abdominal fat is metabolically active tissue that increases insulin resistance, drives inflammation, and significantly raises cardiovascular risk. People with HIV already have elevated cardiovascular risk; lipodystrophy makes it worse.
"The fat isn't just in the wrong place - it's the wrong kind of fat."
Older antiretroviral drugs (especially stavudine, zidovudine, and some protease inhibitors) are the main culprits. Newer regimens are less likely to cause lipodystrophy, but for those already affected, the changes can persist even after switching medications. That's where tesamorelin comes in - it's the only FDA-approved treatment specifically for this condition.